System for access into bodily cavity

ABSTRACT

An assembly and method for percutaneous placement of a catheter comprising an elongated hollow catheter having a distal end and a reduced cross-section portion at a proximal end thereof. An introducer needle is slidably mounted over said catheter. The introducer needle has an elongated slit adapted to slide over the reduced cross-section portion to separate the needle from the catheter. A syringe may be attached to the proximal end of the catheter. Also, a valve may be attached to the catheter to permit easy collection of fluid.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of allowed U.S. application Ser. No.13/346,346, filed Jan. 9, 2012, which is a divisional of U.S.application Ser. No. 11/067,729, filed Mar. 1, 2005, now U.S. Pat. No.8,105,284, the entire disclosures of which, including the drawings, areincorporated herein by reference in their entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to medical instruments and in particular a systemthat establishes percutaneous access to a blood vessel or body cavity(which would include an abscess or pleural or peritoneal or pericardialor epidural or subarachnoid spaces).

2. Related Art

It is frequently necessary to establish access to an internal portion ofthe body for the purpose of removal of fluid, administration ofmedication, establishing a drainage path and the like. A typicalapplication is placement of a catheter in a blood vessel for collectionof blood over an extended period of time. This same catheter can be usedfor the intravenous administration of drugs and anesthesia. Delivery isnot limited to vascular access but also for establishing caudal andlumber epidural blocks for the production of local or regionalanesthesia by infiltration techniques. Another common use for catheterplacement is to establish a drainage path for the pleural or peritonealor pericardial spaces or from a surgery site or abscess.

As used herein, the term “proximal end” refers to that portion of thesystem that is above the skin line and is accessible. The term “distalend” refers to that portion of the system that is inserted into thebody, such as the tip of the needle or end of the catheter.

A typical procedure involves the placement of a catheter, typicallyflexible and of a plastic material, into the space occupied area withthe proximal end affixed at skin level. A thorocentesis kit may be usedwhich employs a needle with a catheter mounted concentrically on theoutside. The length of the needle is somewhat longer that the catheterso that the sharp tapered end projects beyond the end of the catheter.The outer end of the catheter is tapered to provide a smooth transitionfrom the outer diameter of the needle to that of the catheter. The innerend of the catheter is sleeved with a connector for subsequentconnection to a collection bag, syringe or cut-off valve. A syringe isattached to the end of the needle. The catheter is then free to slide onthe outside of the needle but is prevented from coming off the needle atthe proximal end by the attachment connector of the needle to thesyringe.

In this procedure the needle pierces the skin and any underlying tissuecarrying with it the catheter. Since the proximal end of the catheter isstopped by the syringe attachment, it advances at the same rate as theneedle. Once a sufficient depth of penetration is achieved by theneedle, the clinician simultaneously withdraws the needle whileadvancing the catheter. The needle acts as a guide for the catheter.Generally accumulation of a small amount of fluid in the syringeprovides an indication that the needle has penetrated to the destinationlocation. The catheter is advanced until its distal end is at thedesired location and then the needle is totally withdrawn. The proximalend of catheter may then be attached to a collection bag for drainage orcollection of bodily fluid. It may also be used as a port for thedelivery of medicine by subsequent introduction of a needle with asyringe loaded with a drug. The catheter proximal end can also be fittedwith a valve for capping the catheter.

One disadvantage of this technique is that the fact that thecatheter-flow circuit must be broken in order to remove the introducerneedle as the needle is removed the catheter is in open fluidcommunication with the environment so that air can enter into the cavityif the pressure gradient favors retrograde flow. Another disadvantage ofthis technique includes the possibility of an unintended needle stick ofthe clinician upon his or her withdrawal of the needle because of thetechnique and materials used in the above described system. Yet anotherdisadvantage of this prior art technique is that the needle must be aslong as the catheter making it cumbersome to handle and manipulate.

Another technique in use employs a large diameter needle that is used toestablish access to the body location where the catheter will be placed.A wire is then passed inside the needle until it has reached theapproximate location at or beyond the distal end of the needle. Theneedle is then withdrawn and the wire remains. A catheter is then slidover the wire as the wire is removed and the catheter remains behind. Aproblem with this technique involves the number of steps required eachof which individually and collectively add levels of potentialcomplications and/or inaccurate distal catheter placement. Frequently,the distal end of the catheter will abut or sometimes dig into the wallof the vessel preventing the withdrawal or delivery of fluid.

SUMMARY OF INVENTION

Given the disadvantages of the prior art, an object of this invention isto provide a system providing reliable access and placement of acatheter into a bodily cavity, an organ, or blood vessel.

Another object of this invention is to provide a medical procedureinvolving a method of catheter placement that is reliable and safer thanprior art allows which includes a system that maintains a closed circuitfrom the beginning to the end of the procedure.

Yet another object of this invention is to provide a percutaneous kitfor intra-vascular or intra-cavitary catheter placement for theadministration of drugs and/or evacuation of fluid.

These and other objects of this invention are accomplished by means of aneedle/catheter combination with a beveled introducer needle able toslide over the catheter. The catheter is longer than the needle. Theouter diameter of the catheter is substantially equal to the internaldiameter of the needle to permit sliding movement over the catheter. Theintroducer needle has a longitudinal slit running its entire length anda flange at the distal end with a knurled grip. The slit defines an opengroove running the length of the needle.

The catheter has a connector section at the proximal end for attachmentof a syringe or valve. The connector has a section of reduced size in agrooved shape whose thickness is equal to the width of the longitudinalslit in the introducer needle. This groove will therefore permit theneedle to pass over it. In one embodiment the connector section isoriented at an angle to the catheter and the reduced section is on theconnector portion and oriented in alignment with the groove whichenables the needle to align with the groove in a seamless manner. Inanother embodiment, the connector is positioned axially at the proximalend of the catheter and the section of reduced size is an elongatedregion of reduced cross-sectional size above the connector.

Another aspect of this invention is the provision of a singledirectional dual ball suction/delivery valve for the collection offluid. The valve has three ports, an output port with a valve attachedto the catheter, an input valve port coupled to a collection bag and aport in fluid communication with both valves connected to a source ofreduced pressure such as a syringe. When suction is created by thesyringe the valve ball moves toward a limiting post opening the orificeemptying the proximal catheter lumen while simultaneously causing asecond ball to seal the orifice of the catheter conducting material to acollection receptacle. When positive pressure is applied by the syringethe first ball is caused to seal closed the orifice to the proximal endof the introduced catheter and simultaneously causing the second ball tomove away from the orifice to the catheter communicating material to thecollection receptacle with the ball being stopped by a limiting post.

In operation of the system, the clinician holds the introducer needle byone hand and stabilizes the catheter with the other hand. The catheteris positioned inside the needle and slightly behind the beveled distalend. The needle punctures the skin and underlying tissue to a desireddepth of penetration. The catheter is then advanced and the needlewithdrawn by sliding the needle over the catheter as the catheter isadvanced. When the proximal end of the needle, with the flange, reachesthe connector section (or area of reduced cross-section) it is strippedoff the catheter along the longitudinal groove. As an alternative tocomplete removal of the needle, it can be docked on the catheter forlater removal but the danger in the delay of removal is that itpotentially exposes an individual to the contents of the space enteredand adds the risk for catheter puncture or shearing by the introducerneedle tip (if mishandled). A syringe and/or a valve are attached to theconnector before the procedure begins.

These and other aspects of this invention will become apparent from thedrawings and the description of the preferred embodiments that follow.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a perspective view of a first preferred embodiment of thisinvention illustrating the components thereof;

FIG. 2 is a perspective view of a second preferred embodiment of thisinvention illustrating the components thereof;

FIG. 3 is a schematic view of the valve used in accordance with thisinvention, and

FIG. 4 is a schematic view illustrating the method of use of thisinvention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIG. 1 a schematic perspective view illustrates theessential components of this invention. The kit 10 comprises threecomponents, a catheter 12, an introducer needle 14 and a syringe body16. The syringe 16 is conventional and need not be discussed further.

The catheter 12 is typically an elongated hollow plastic tube ofsuitable internal diameter and stiffness. The distal end 18 is beveledand tapered to aid in penetration. The bevel matches that of the needle.The proximal end has a connector section 20. In this preferredembodiment the connector section 20 is oriented 90° to the axis of thecatheter via an elbow portion. It is apparent that the connector section20 need not be at right angles to the axis of the connector. Thissection has a flange 22 and a hole 24 into which the syringe 16 isinserted. It is apparent that a valved “Y” connector can also beattached at this point instead of the syringe.

The connector has a flattened section 26 which is aligned with thelongitudinal axis of the catheter that is parallel to the internal boreof the catheter. The outer thickness of the section 26 matches the widthof the slit of the introducer needle, as will be explained herein.

The introducer needle 14 is metal or rigid plastic. It has a distal endthat is sharpened and beveled. The proximal end has a holding flange 30.This is in the form of a tab portion suitably roughened by knurling orthe like to provide a secure thumb and finger grip. Preferably the tabportion is wrapped around the needle to provide two protruding ends.

The introducer needle has a longitudinal groove or slit running thelength of the needle. As illustrated the needle circumference is about270° with the groove comprising about 90°. The exact angular extent ofthe wrap around of the needle 14 vis-à-vis the catheter 12 is notcritical so long as the needle is held in position on the catheter, thatis, a co-axial relationship is maintained during the placement phase ofthe procedure. The groove may be as large as slightly less than 180° inthe case of a relatively stiff and/or large diameter catheter where ineither case the catheter will support the needle. It may alternativelybe relatively thin in the case of flexible catheter requiring a greaterdegree of support about its circumference.

A second preferred embodiment is illustrated in FIG. 2 Like elements areidentified with the same numbering as in FIG. 1 and need not bediscussed. In this embodiment, the catheter 12 has two sections, a fulldiameter portion 34 and a reduced diameter portion 36. The introducerneedle 14 is mounted on the full diameter portion 34 and is slidable asin the first preferred embodiment. The reduced diameter portion 36 isused to remove the needle from the catheter, as will be describedherein. While the connector is illustrated as coaxial with the catheter,it is apparent that it could be angled as in the first preferredembodiment.

The operation of the invention will now be described. In the FIG. 1embodiment the catheter 12 and the introducer needle 14 are eitherpre-assembled as illustrated in the figure or the needle is slid overthe distal end of the catheter. The distal ends of the needle andcatheter are aligned so that the bevels 18 and 28 co-incident with eachother. The clinician then holds the catheter in one hand by the knurledportions of the needle flanges and the tab 30 with the other. Theassembled needle 14 and catheter 12 are then percutaneously insertedintra-vascular or intra-cavitary to a proximal position. Then, holdingthe needle in a stationary position, the catheter is advanced to thedesired placement position. As such, the needle moves relativelybackward toward the proximal end that is closer to the connector 20.

With the catheter in its proper position, the needle is fully retractedby a sliding movement using the tab 30. When the tab reaches theconnector 22, the tab portions 30 are either spread apart or peeled backto a position opposite the slit 32. The needle then passes over theconnector with the slit riding over the reduced cross-sectional portion26. As such the needle is removed and can be discarded by merely holdingit and moving the needle with the tabs 30. This is illustrated in FIG.4. Alternatively, the needle 14 may be “docked”, that is left inposition adjacent the connector for removal at a later date.

In the case of the embodiment of FIG. 2, the introducer needle 14 isslid down the length of the catheter until it reaches the reduceddiameter portion 36. The tabs are then reversed and the needle strippedoff the catheter. As in the FIG. 1 embodiment, the needle may be dockedover the reduced section but again the risks related to delayed needleremoval include catheter puncture or shearing by the introducer needletip if mishandled.

In both embodiments the syringe 16 or a stop valve, not illustrated, canbe attached to the catheter at any point in the procedure. That is, itmay be affixed to the connector 20 before the needle is introduced orafter the needle is stripped off, or at any time in between. The syringecan be used for the introduction of medicine or as a space occupiedevacuation system.

It will be appreciated that by this combination of introducer needle andcatheter achieves accurate percutaneous placement of a catheter and yetthe needle can be easily withdrawn and safely removed without disturbingthe catheter or forcing a break in the collection circuit.

A valve for use with this system is illustrated in FIG. 3. The valve 40has a hollow body portion 42 with three ports 44, 46 and 48. The bodyportion 42 has an internal wall 60 with a pair of thru-holes 62, 64.Port 44 is an open conduit to be attached to a source of reducedpressure such as suction or, as illustrated, syringe 16. Two stopelements 50, 52 are positioned in ports 46 and 48 respectively. The stopelements each have a stopper 54 and a guide 56. The stoppers 54 aresized to seal either the port 46 and prevent backflow into port 46 oropening 64. The stop elements are reversed, as shown, so that port 46constitutes and “IN” and port 48 an “OUT”.

The port 46 is typically connected to the catheter 12 via the connector20. The port 48 is attached to a collection bag, not illustrated. Inoperation with these components attached, when the syringe piston iswithdrawn pressure within the body 42 is reduced causing stopperelements 50 and 52 to move toward and seat on the wall 60. In thisposition, fluid communication is established between catheter 12 andhollow body portion 42 while the stopper 54 seals the OUTPUT 48. By theapplication of further suction by action of the syringe, the body 42 andpotentially the syringe body 16 will fill with fluid. When the piston isadvanced, the stoppers 50 and 52 move toward the ports 46 and 48. Thisseals the INPUT 46 and opens the OUTPUT 48 allowing the fluid to becollected in the collection bag.

It will be appreciated that if the source of suction coupled to port 44is another source, such as a continuous vacuum, the material collectedcan be immediately and directly removed.

It is apparent that alternatives of these embodiments are within thescope of this invention. For example, the cross section of the needleand catheter need not be round. It can be configured to anycross-sectional shape desired as a function of the procedure, such asoval, triangular or the like. The tab on the introducer needle does nothave to be knurled to provide a grip. It may be perforated, corrugated,roughened by other techniques or made sticky to tactile grip. The tabmay be modified to be a fixed protrusion on the needle at a positionthat does not block the groove.

The dimensions of the longitudinal groove and the geometry are functionsof the materials used and the diameter of the catheter. In the case of arelatively thin and/or flexible catheter the groove may be thin andstill allow the needle to be stripped off. If the catheter is relativelystiff, the groove may be larger, approaching one-half the circumferenceof the needle yet the needle will still be held on the catheter buteasily stripped off. Although not illustrated, the groove may have awider circumferential portion at the proximal end to facilitate thestripping process by “starting” the needle off of the catheter.

Additionally the connector section can have a stop valve attached ormade integral to it to prevent fluid communication between the catheterand ambient conditions.

I claim:
 1. A method of removing fluid from a body cavity by thepercutaneous placing a catheter having an elongated hollow catheter witha reduced cross-section portion at a proximal end thereof and, anintroducer needle slidably mounted over said catheter, said introducerneedle having an elongated slit comprising the steps of; advancing saidneedle and said catheter percutaneously to a desired position,withdrawing said needle while maintaining the position of said catheterand, sliding said elongated slit over said reduced cross-section portionto separate said introducer needle from said catheter, attaching a valveassembly having three ports to the proximal end of said catheter usingone of said three ports, attaching source of reduced pressure to asecond port, attaching a collection device to said third port, operatingsaid source of reduced pressure to draw fluid from said catheter andinto said collection device by operation of said valve assembly.
 2. Themethod of claim 1 wherein the step of attaching a source of reducedpressure comprises the step of attaching a syringe to the proximal endof said catheter.
 3. The method of claim 2 wherein the step operatingsaid source of reduced pressure comprises the step of pleural evacuationby withdrawal of bodily fluid through said catheter and into saidsyringe.
 4. The method of claim 1 further comprising the step ofintroducing a drug intra-vascularly from said syringe and into saidcatheter.
 5. The method of claim 1 further comprising the step ofintroducing a drug intra-cavitarly from said syringe and into saidcatheter.
 6. The method of claim 1 wherein the step of withdrawing saidneedle comprises a step of temporarily docking said needle prior tocomplete withdrawal.